Onkológia 5/2008
ACUTE LYMPHOBLASTIC LEUKEMIA AMONG CHILDREN – LONG-TERM RESULTS
Acute lymphoblastic leukemia (ALL) is the most common cancer among children. The incidence is 30 – 40 new cases per 1 million children up to 15 years old. The peak incidence of ALL occurs between 2 and 5 years of age. With the current treatment protocols complete remission can be reached in more than 95 % of children and overall survival is between 75 – 85 %. The most important prognostic factors are age, ploidy, chromosomal abnormalities in blasts, response to prednisone prephase and after induction and lately also monitoring of minimal residual disease during and after induction. Adequate antileukemic and supportive treatment, centralized care and experienced staff are essential aspects too. Adolescents, infants and patients with Ph positive ALL are groups with less favourable outcome. Allogeneic transplantation of PBSC is reserved for high risk patients in the 1st complete remission and for patients with an early relapse. The improved survival in children with ALL has focused on the late effects of antileukemic therapy. Better understanding of minimal residual disease will help to treat patients more individually. In the future molecular targeted therapy can replace or support the effect of cytostatic treatment and change the toxicity profile as well as long term sequelae.
Keywords: acute lymphoblastic leukemia in children, prognostic factors, long-term survival, allogeneic transplantation, recurrent ALL, long-term effects
